| NPI | 1497855548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 57201) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY P51490) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2023-03-28 |